Abdominal distention is a common presenting clinical sign in ruminants. Cattle are susceptible to a variety of abdominal syndromes including esophageal obstruction, free gas and frothy bloat, omasal obstruction, abomasal outflow obstruction and displacement, intussusception, and other intestinal disease. Not all abdominal distention is the same and critical evaluation of the abdomen from a distance can provide important initial clues as to the source of disease. The most critical physical examination parameters for evaluating animals with abdominal disease will be reviewed and interpreted, along with the various abdominal shapes. Ancillary diagnostic techniques including rumen fluid analysis, complete blood count and serum biochemistry, abdominocentesis and diagnostic ultrasound will be discussed. Vagal indigestion syndrome will be among the disease syndromes reviewed. General therapeutic principles for abdominal disease will be reviewed, including antimicrobial selection, fluid therapy, anti-inflammatory and analgesic therapy. Placement of a field-friendly rumenostomy will also be reviewed.